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Place of death in a small island state: a death certificate population study
  1. Nicholas Jennings1,2,
  2. Kenneth Chambaere1,
  3. Luc Deliens1,3 and
  4. Joachim Cohen1
  1. 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
  2. 2 Bioethics Department, St George’s University School of Medicine, St George's, Grenada
  3. 3 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Nicholas Jennings, End-of-Life Care Research Group, Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels B-1090, Belgium; nicholas.jennings{at}


Objectives Low/middle-income countries, particularly Small Island Developing States, face many challenges including providing good palliative care and choice in place of care and death, but evidence of the circumstances of dying to inform policy is often lacking. This study explores where people die in Trinidad and Tobago and examines and describes the factors associated with place of death.

Methods A population-level analysis of routinely collected death certificate and supplementary health data where the unit of analysis was the recorded death. We followed the Reporting of Studies Conducted Using Observational Routinely Collected Health Data reporting guidelines, an extension of Strengthening the Reporting of Observational Studies in Epidemiology, on a deidentified data set on decedents (n=10 221) extracted from International Statistical Classification of Diseases version 10 coded death records for the most recent available year, 2010.

Results Of all deaths, 55.4% occurred in a government hospital and 29.7% in a private home; 65.3% occurred in people aged 60 years and older. Cardiovascular disease (23.6%), malignancies (15.5%) and diabetes mellitus (14.7%) accounted for over half of all deaths. Dying at home becomes more likely with increasing age (70–89 years (OR 1.91, 95% CI 1.73 to 2.10) and 90–highest (OR 3.63, 95% CI 3.08 to 4.27)), and less likely for people with malignancies (OR 0.85, 95% CI 0.74 to 0.97), cerebrovascular disease (OR 0.61, 95% CI 0.51 to 0.72) and respiratory disease (OR 0.74, 95% CI 0.59 to 0.91).

Conclusion Place of death is influenced by age, sex, race/ethnicity, underlying cause of death and urbanisation. There is inequality between ethnic groups regarding place of care and death; availability, affordability and access to end-of-life care in different settings require attention.

  • place of death
  • death certificates
  • Trinidad and Tobago
  • palliative care
  • developing country
  • public health

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  • Funding This study was funded by the Research Council of the Vrije Universiteit Brussel: Strategic Research Programs (SRP 4).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data of this study are with the first author and are available upon request.